Does the blood salvage device used in orthopedic surgery damage blood cells, similar to those used in cardiac surgery?

Cell Salvage in Orthopedic Surgery Does Not Damage Blood Cells Like Cardiac Surgery Devices

Cell salvage devices used in orthopedic surgery do not cause the same level of blood cell damage as those used during cardiac surgery, making them a safe and effective blood conservation strategy. 1

Differences Between Cardiac and Orthopedic Cell Salvage

Cardiac Surgery Cell Salvage

• During cardiac bypass, cardiotomy suckers collect blood from the surgical field and return it directly to the bypass reservoir without processing, which can lead to depletion of clotting factors and platelets 1
• The use of cell salvage during bypass (instead of cardiotomy suckers) is not recommended due to resulting depletion of clotting factors and platelets 1
• After bypass, 500-1000 ml of blood remains in the bypass circuit, which when returned unprocessed may contribute to coagulation issues 1

Orthopedic Surgery Cell Salvage

• Cell salvage in orthopedic procedures provides excellent quality red blood cells that maintain normal functional and metabolic status 2
• Analysis of blood collected during orthopedic procedures shows no significant damage to red blood cells, with normal morphology and cellular function 2
• Orthopedic cell salvage significantly reduces allogeneic blood transfusion requirements without significant side effects 3, 2

Effectiveness and Safety of Orthopedic Cell Salvage

• Meta-analyses of randomized trials show that cell salvage devices in orthopedic surgery considerably decrease the proportion of patients requiring allogeneic transfusion (RR = 0.39,95% CI = 0.30-0.51) 3
• Cell salvage is particularly valuable in orthopedic operations where tourniquets cannot be applied, such as hip arthroplasty or spinal surgery 1
• Intra-operative cell salvage significantly reduces red cell transfusion exposure rate and volume of allogeneic red cells transfused in hip and knee arthroplasties 1

Practical Considerations for Orthopedic Cell Salvage

• Cell salvage should be considered in all orthopedic or trauma surgery when blood loss is expected to be > 500 ml 1
• Important precautions to maintain blood quality in orthopedic surgery:
  • Do not use cell salvage while bone cement is being applied; resume when cement is fully set 1
  • In revision surgery with metalwork in situ, use standard suction until the surgical field has been irrigated and metal fragments removed 1
  • Avoid using cell salvage while the surgical field is contaminated with antibiotics, iodine, or topical clotting agents 1

Quality of Salvaged Blood in Orthopedic Surgery

• Blood collected during spinal surgery shows lower hematological values and higher plasma-free hemoglobin than preoperative blood, but without disturbances in morphology or cellular function 2
• Salvaged blood from orthopedic procedures maintains normal adenosine triphosphate (ATP) and diphosphoglycerate (DPG) content, indicating preserved red cell function 2
• Cell salvage in orthopedic surgery has not been associated with major complications 4, 2

Limitations and Considerations

• In some knee replacement procedures, the volume of salvageable blood may be relatively small (mean postoperative red cell loss of 121 ± 50 mL), representing only about 16.8% of overall red cell loss 5
• For maximum effectiveness in knee surgery, cell salvage equipment should be set up for use once the tourniquet has been released 1
• The cost-effectiveness of cell salvage varies based on the type of orthopedic procedure and expected blood loss 1

In conclusion, while cardiac surgery cell salvage has limitations related to blood cell damage and coagulation factor depletion, orthopedic cell salvage provides high-quality red cells with minimal damage, making it a safe and effective blood conservation strategy for appropriate orthopedic procedures.